'Uber-style' private GP appointment service primed for national rollout

A new private GP company offering ‘Uber’-style GP appointments is preparing to roll out the service across the whole of England after a successful pilot in two north London boroughs.

The Doctaly service doesn’t employ GPs itself, but is the first reported service to match NHS GPs to patients who are prepared to pay a fee to avoid the usual wait to see their GP.

The GPs will see patients in their own practice and in their spare time, the company says.

But GP leaders warned they are ‘very concerned’ about the service, which they said would destabilise general practice and undermine the NHS, and encourages ‘queue-jumping’ for patients who can afford it.

Doctaly has been running for the past month at 10 practices in the London boroughs of Barnet and Enfield, with around 50 GPs signed up to offer appointments at various times.

The service is not yet available as an app, with patients booking appointments through the Doctaly website.

But the company has been likened to Uber – an app that allows customers to book taxis – because it does not employ the GPs directly, instead providing them with the framework to offer the appointments and then taking a cut of the fee.

Doctaly told Pulse that having proved the concept could work – with both patients and GPs keen to sign up – the service is now being rolled out with the aim of reaching the rest of London by the end of this year and the whole country by 2018.

Company founder Ben Teichman insisted the service is not about queue jumping but ‘quite the opposite’.

He said: ‘Doctaly is essentially a hybrid service between the NHS and existing private practice making private appointments more affordable, thereby opening them up to a wider audience.

‘It is not about queue jumping. Quite the opposite in fact. It should help drive queues down in surgeries and also take traffic away from A&E. An A&E appointment can cost the NHS £150 and if access wasn’t an issue, many of these patients could have been successfully treated by a GP.’

He said that the service was a ‘lucrative and convenient alternative’ for part-time GPs, and even full-time GPs who may ’want to do a few appointments on their admin day if they’ve got time’.

But Dr Jackie Applebee, chair of Tower Hamlets LMC in east London and Doctors in Unite representative on the GPC, said the service was ‘very worrying’ and would ‘further destabilise general practice’.

Dr Applebee added: ‘This is not the answer to the crisis in general practice. I acknowledge that access is a problem, but the fault for this lies at the door of the Government who have disinvested in general practice for years so that we now have an unprecedented workforce crisis.

‘This sort of service is the slippery slope towards privatisation of the NHS. It introduces the principle of topping up NHS services with purchased services if one has the disposable income. If the more affluent begin to do this in significant numbers it is only a small step to an insurance-based health service.’

GPC deputy chair Dr Richard Vautrey said: ‘Patients want and deserve a properly funded NHS GP service, based on the registered list, so they can get appropriate timely access to their local GP and that practices have the resources and capacity to offer this.

‘While patients can access and pay for private GPs or consultants, the risk is a more fragmented service and patients having remote consultations with doctors they don’t know and who won’t have full access to their NHS medical record.’

How ‘Uber GP’ appointments work

Ben Teichman set up Doctaly with the help of a GP friend, Dr Dinesh Silva, after finding he had to wait two weeks for a GP appointment.

Under the model, a senior partner at a practice holds a contract with Doctaly and then any GPs at that practice are free to register a profile on the company’s website and offer appointment slots when they are available.

Doctaly pays the practice a cumulative fee each month based on the number of consultations provided, and the practice then calculates how each GP should be remunerated – salaried GPs may have some of the fee deducted, for example to cover use of the room and reception staff.

Patients use the website to choose a doctor and book a 15-minute appointment slot, paying from £39.99 to £69.99 depending on the time and day of the week. The booking process requires the patient to confirm that they are not registered with the particular GP practice they choose.

Patients are also advised Doctaly does not provide emergency care, and that patients needing care for psychological problems or long-term condition management are better off going to their regular GP who understands their medical history.

After a Doctaly consultation, the GP provides the patient with a printed copy of the consultation notes and the patient is free to decide whether not not they wish to share the information with their NHS GP.

At the moment there is no encouragement for NHS GPs to see patients. A good day for a UK GP is a quiet day. In Australia that is a disaster, if no patients then no income at all. So NHS has to consider element of Fee for Service or the private sector will fill that space...adding further encouragement for GPs NOT be rid of waiting lists. Indeed all UK private practice depends on NHS waiting lists, which was why Fundholding was abolished. The hospital consultants could not tolerate loss of private income so lobbied accordingly.

Excellent idea. As GPs, we are experienced and could deal with a huge number of physical and mental conditions at a secondary care level. This training is being wasted because of our ridiculous NHS contract.

The only problem with this excellent service is that most patients want rapid access to see their own NHS GP. Patients tend to have on going problems and want continuity of care. Similarly most GPs would happily spend more time with their NHS registered patients, IF they were paid for it. Putting aside simple clinical problems (though just dealing with these is probably enough to run a successful business model), a GP needs to have full access to NHS notes. Without this it can be difficult to understand the complexity of a patient's problems.

Of course what really needs to happen is to change the GP contract so that we get paid according to what we do, like everywhere else in the world. Alternatively NHSE needs to define exactly what a GP is supposed to do for £110 per year.

It seems to be using practice premises and resources which are largely NHS resourced. We are going down a slope quite quickly here with big implications. If co-payment is going to be a thing (which I think it is), it needs to be properly debated and understood by all NHS users.

1. The premises issue. AS an owner occupier the NHS pays me a rental for use of my premises within contracted hours. I am at liberty to see as many private patients as I like in those times but if the private income exceeds 10% of practice income, the rent is abated. I pay the staff. The NHS does not. There is money in the Global Sum intended to pay the staff in contracted hours. Any money I spend on staff cones from my pocket. 2. The elephant in the system. Prescriptions. See à patient privately and they must have private scripts. Fine for Wondercillin. But what if they need a Prostap injection at £285? Or if you are trying to give best choice treatment for hypertension? I would not be amused if my patients rock up (or ring up) demanding that I change their private script to an NHS one as it's their right... Actually this, and the restriction of trade which prevents my patients choosing to pay to see me on a Saturday when I am not contracted to care for them on the NHS, is what stands in the way of a mixed NHS/Private economy